Provider Demographics
NPI:1861651531
Name:AUSLOOS, TAMARA
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:AUSLOOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 ERIE AVENUE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3658
Mailing Address - Country:US
Mailing Address - Phone:920-459-3028
Mailing Address - Fax:920-459-4341
Practice Address - Street 1:3014 ERIE AVENUE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3658
Practice Address - Country:US
Practice Address - Phone:920-459-3028
Practice Address - Fax:920-459-4341
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3184-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist